Disclaimer: Although the cases I discuss are true, to protect the identity of my patients and myself certain details may be changed. Examples of items that may be changed include a person's gender, age, gravidy and parity, and so on.

Thursday, November 09, 2006

Fantasy

We've all got our fingers crossed about a baby who went home today. Born at 27 weeks gestation, she needed to be on oxygen for a long time but otherwise did very well. Her twin went home a few days ago. Our fingers are crossed because mom is not exactly a shining star. She's very nice but young (16) and a bit slow. She takes some, but not all, special ed classes. Teaching her things like the need to support the head of a baby when holding her, what a pediatrician is, and so on took extra effort. Her guardian is her grandmother who is wheelchair bound.

Social services checked out the situation. It's one of those deals where the family isn't bad enough to justify removing the children from the parent but is bad enough to make us, the doctors and nurses who cared for her, pretty worried.

In the next room in our NICU lies a baby who is very sick from an infection. I'm not sure if he will be alive tomorrow morning when I go to work. His parents are very nice and have visited him together every day since he was born six weeks ago. They seem like they would make great parents, and they'll be devastated if their baby dies.

It makes me wish that sometimes I could just switch the parents around. I mean, wouldn't it be better if the 16 year old mom, who is barely bright enough to manage routine child care, had the baby who died, and the other parents, so excited about their baby, had the twins who should do pretty well in a decent home? Don't take this to mean that I think dumb parents wouldn't feel the loss very hard if their baby died. I know they would; you don't have to be smart to love your kids. But it's just not fair. The sixteen year old, who needs a baby like she needs a hole in the head, has two, and we hope like crazy that they are resilient enough to take some subpar parenting, while the other parents might have none.

I guess we can't fix everything, and I should probably focus on keeping the six week old alive instead of fantasizing about switching parents.

24 Comments:

You'll probably get flamed for this post too, but I think it's only fair to note that you're not the only NICU person who's had that fantasy.

We wouldn't switch them if we could, but as you said -- fantasy.

But perhaps it wasn't always. I spoke to the dad of a patient last weekend whose great-grandmother swore until the day she died that one of her babies was taken from her and given to the wealthy, powerful woman in the private room. She fed the baby once and then was told that her baby died, but never shown the dead baby. This would have been nearly 100 years ago and the great-grandmother was a new immigrant who barely spoke English.

neodoc,i have thought this before also.remebering a woman who was a gravida 5 with none of her children living with her(state had them all)and the poor woman who on that day had a beautiful baby with a lethal trisomy.i vividly remember the mother of the sick infant crying so piteously as the neo broke the news" but i did everything right,i took good care of myself,how did i mess up?" and the compassionate neo reassuring her,no,it was not her fault.and i remeber that day thinking,why couldn't this poor woman have had the healthy baby......

Well you are absolutely right. While the stupid mother will, no doubt, be sad at the baby's death, the baby and the mother are better off. Likewise if the smart parents' baby survived. But then if everything were perfect, then where would our next generation of drug peddlers. serial killers and gangsters come from!

What a sad, desperate situation. We recently adopted a cat from a local humane society and had to go through an inordinate amount of interviewing, background checking, and making of promises related to her care before they would release what at one time was a stray cat to us. But anybody at all can bring a baby into the world.

I felt these same thoughts when I was trying so desparately to get pregnant with my youngest. I would see all the young tees all bulging and not having a clue and think why them and not me. Even though I was one of "them" the first time around....

Just give her all the wisdom you can showve into her head while you have her in your presence. Encourage her to be the best mom she can be - thats what my wonderful peds doc did when I had my first at barely 16 - and she turned out beautifully in spite of having a child for a mother.

These are the thoughts that make us lay-people wonder if doctors think they are God. You can't change things like that, so why even bother considering the better outcome.

Why were either of my daughters born into families who would turn around and give them to someone else to raise while my husband and I endured years of infertility? Wouldn't it have been easier if we had been blessed with the children instead of their birth parents?

Why are children born to parents who abuse, abandon and even murder them when there are so many families battling infertility or struggling through the adoption process?

Herein lies the reasoning: I would not be the person I am if I had not gone through infertility. I would not have the people I have in my life had I not gone through the adoption process. There is a reason behind everything, even if we are not meant to understand it.

Having spent over 100 days in the NICU with my trips, who were born at 27 weeks, i can completely relate to what you are saying. I had to use donor eggs to conceive my boys and I watched as these young clueless kids came and went with their new babies. It made me angry at times because I went that far to have a baby and the others who had babes there didnt really care much about them. Or how to handle their special needs when they went home. I guess I was there so long that I saw everything. The good the bad and the ugly. Now I know why our neonatal doc always compliments us on how great the boys are doing. They all came home on O2 and monitors and tons of meds. Now they are on a reflux med. Which is no big deal to me seeing where they came from. Thanks for being so honest.

Thanks for posting what I thought SO MANY times while doing child welfare.

I removed a baby the same day I got a negative beta. Then AF showed up while doing the paperwork to check him into the shelter. I sat in the bathroom and sobbed.

I wanted to give his mom who left him with strangers and never came back my negative and barren (at that time) womb and take that little boy home to love.

I don't think any of us in this field cannot help but wonder this.

I came to realize that life is not fair. I came to realize that this was my path and no one else's.

I hope that 16 year old can do this, but I hold little hope. She sounds a lot like the mother of the baby I just described. She ended up losing that baby, and had her rights terminated because she could not do the things required of her to get him back. She had him back, on a trial home placement, but could keep it up. We worked VERY hard for her to get him back, but she was unable to take the care he needed.

At 24 weeks gestation, I learned that my baby had holoprosencephaly. I was told that he would most likely be stillborn, and if he did survive to be born alive, he probably wouldn't live long. He's now 3 1/2 years old!

He was breech and I had pre-eclampsia, so he was born via c-section at 37 weeks. On the morning of my scheduled c-section, I was waiting and try to relax in triage.

On the other side of the curtain, a pregnant woman had arrived for for her scheduled c-section. It was impossible not to hear her conversations with the medical staff as she was asked the same questions I had been asked; however, her answers were quite different from mine.

Q: Have you drank alcohol during your pregnancy?A: Yes

Q: Have you smoked during your pregnancy?A: Yes

Q: Have you taken any illegal substances during your pregnancy?A: Yes

Q: When was the last time you took those drugs?A: Two weeks ago

My heart broke as I listened to her questions and the answers knowing that I had taken care of myself and my baby throughout my pregnancy, while this mother was abusing herself and her unborn child.

My husband was next to me also listening to her responses to the questions, and when our eyes met, I knew that he was thinking the same thing that I was thinking, "We did everything right, and she did everything wrong. Our baby has a severe birth defect that we didn't cause; yet, she will probably have a healthy and normal baby that she doesn't deserve."

It was only a matter of days before I came to realize the truth. I realized that our son was chosen for us because we would give him everything that he would ever need. We would love him, protect him, and celebrate him.

I don't know what happened with that other mom and her baby; however, I do know that if my precious son had been born to the mother on the other side of the curtain, he wouldn't be alive today.

While it is true that my son is severely disabled, not a day goes by when I'm not thankful for the privilege of being my son's mom. I wouldn't trade him for anything in the world! His medical condition is not a punishment for life mistakes I've made; his life is a precious reward.

I've always worried about kids in bad places. And maybe this mom's place isn't so bad, just worrisome. An OLD friend of mine had a baby a year or so ago (she lives in Washington, I live in AL) and when he was born she said something over the phone to me that made me physically ill..."Oh, he's such an easy baby...he's on my eating schedule from when I was pregnant so he only wants to eat three times a day and then sleeps all night long." HE WAS A NEWBORN. I tried my best to tactfully explain to her how infants should eat.. I don't know if it worked. I stopped talking to her, there was nothing I could do.

i don't believe your thoughts here are part of the erroneous assumption that you're just another doc with a god-complex.no, i think any human with compassion in their heart has looked upon a sad situation like this and wwish that it could be different. i believe that it is part of human nature to sometimes feel that way.i have seen many similar situations like you described in my nicu practice and i am not a doctor nor am i God.

I don't think good people deserve healthy babies. I think all babies deserve good parents. So in a way I don't disagree with what has been said in the comments here, but I do think we have the logic backwards. Healthy babies aren't a reward for good behavior, they're a spontaneous blessing and a gift that ought to be treasured and treated with the greatest care.

What came to mind for me when I read NNdoc's post was this:When I was a NICU mom for the second time (2004), I had a surreal moment of clarity one afternoon while visiting my son.

I was 32 at the time, and had 9 years of school teaching "under my belt". Our NICU has the isolettes placed in squares, basically, so your little corner of the room has 4 babies in it. I'd not yet seen the mom of one of those babies, she was never there when I was. But on this afternoon, she came in while I was at the bedside. I recognized her instantly, and she did me too. You know how you can just tell by the eye contact--we were both saying "I know you". We could not have been more dissimilar.......different races, different upbringings and socio-economic levels, and she was an unmarried teenager while I was a long-married mom of two. She also just happened to be one of my former STUDENTS from a previous teaching job!

In this moment, however, as we acknowledged each other, it seemed as if we were exactly alike....both NICU moms whose sons were struggling and dealing with PDAs and other complications, and we were worried sick and dealing with it the best way we could.

It was a little startling to have that kind of connection with this young lady. She'd been a "bad" student, both academically and behaviorally, but none of that mattered now because we were both just worried moms of sick preemies.

Just another perspective. I've wondered what happened to them after they were discharged. Her baby was older than mine, and left first so I never got to know what became of them.

As a 19 year old who just lost a baby to triploidy (a random genetic defect that almost never results in live birth) after 8 short days in the NICU, reading this pained me. I'm single, but not an idiot. I realize how much you worry about the welfare about babies you've worked so hard to save. However, grief is grief and losing a baby is heartbreaking regardless of your age/socioeconomic status.

You know.. I hate to say it, but I have thought the same thing as well.It is the age-old question.. why do bad things happen to good people?Sometimes I wish it was on a who deserves what basis, but apparently that isn't how life works.

I have thought the same thing so flames here. So many times I have seen big pregnant women doing what they wanted until the day that they naturally went into labor. Some of these women have sub par parenting skills, did drugs,. drank, smoked during pregnancy. I did EVERYTHING right. I spent the entire pregnancy on modified bedrest, then the last month and half on very strict bedrest (I was told not to move a muslce till my next appt). I still delivered over a month early. I was lucky my baby was ok. But I have seen so many moms that desparately want a baby. Then you have the 14 year old who gets pregnant and has a healthy baby and no clue on how to care for them. No slamming here. It is something we have all thought.

Thanks, everyone. I can see I'm not the only one to think such things. Anonymous 5:03, I don't put all single or welfare moms in this category, or think they are all dumb. Some do great with their babies. But this mom looked like she might have trouble.

Being slow or even mentally retarded does not equal being stupid. Saying ignorant things about which you know nothing makes you stupid.

To Sammys mom: I believe you are exactly right. Our children are gifts and we are BLESSED to have them, MR, defects, whatever. They are OURS and I know I wouldn't trade my guy for any "normal" baby in the universe!

I was a teenage mom, had my first child at 16, then married her dad and had, over 23 years, 6 more children. When my son was DXd prenatally with DS, I did have those "why me, why not the drug abuser or whoever" thoughts. I quickly realized that I was being silly. There are those who think you get what you deserve, and if they think I deserve my son, being who he is...I have to thank them from the bottom of my heart for such a lovely compliment.

I know this is neither here nor there and doesn't really pertain to your post but I have to say something about this. You say this 16 year old is very slow, shouldn't protective services atleast attempt to find out who the father is. She could be sexually abused and all you can think about is that she is out there getting pregnant all the time. Sorry just a thought that entered my mind.

What if that little baby of the mother who is not bright grows up not to be a bright one either because of genetics. Baby probably will be very bright due to a good self esteem or good genetics from the father. But the question is would you want to take the future children away from the child born to a not very bright mother who fell into the same category? I wonder if some new parents are not actually stupid but have an emotional fear that they will fail at all things as a first time parent. So they may stuff up with basic parenting due to the low self esteem from the fear of stuffing up in front of others. Some may have been told all there life they are stupid and would fail in life at all things and actually begin to believe that they are usless and stuipd. If this is the case for them they feel that they would make bad parents. At some point society has to make an effort to train and bring confidence back to those parents who have had hard lives and feel like failures.

I do think its the bright ones that are destined to care for special needs children. They are the ones that have it in them too take care of special needs kids. Perhaps the healthy bright kids despite the care of the not so bright parents will be the independent one to teach mom or dad someday when they are adults about lifes lessons of love comes in many forms regardless, of iq and social status.